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Archived: The Chestnuts Nursing and Dementia Care Home

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All reports

Inspection report

Date of Inspection: 18 July 2011
Date of Publication: 29 September 2011
Inspection Report published 29 September 2011 PDF

There should be enough members of staff to keep people safe and meet their health and welfare needs (outcome 13)

Meeting this standard

We checked that people who use this service

  • Are safe and their health and welfare needs are met by sufficient numbers of appropriate staff.

How this check was done

Our judgement

A system was in place to determine the levels and suitability of staff required to meet peoples’ care and support needs. However, there were times when peoples’ needs were not appropriately met by the numbers of staff on duty.

User experience

People told us that staff were kind to them and available when they needed them. One person told us; “They all look after me – it’s like one big happy family”. Another person told us that they had a named nurse and a key-worker and they were usually available. There were 47 people in the home at the time of our visit and the staffing compliment was two qualified nurses and nine carers on day shifts and two nurses and four carers on the night shift. We looked at the rosters and saw a consistent pattern of staffing in place. We became concerned to see one member of staff feeding two people during the lunch period. We also saw staff feeding people, leaving them briefly and then return to the dining area. We formed the view that the staffing levels were not sufficient to meet the support needs of people using the service at that time.

Other evidence

We spoke to the manager about our concerns and she was uncertain as to why this had occurred. There was no written evidence available to show how the staffing levels were deployed throughout the home. The manager told us that it was based on the number of people in the home and their needs. We then asked about the overall staffing compliment and were told that there were eight full-time staff nurses, six bank nurses with one vacant position. In addition there were six senior carers with three vacancies and a total of 36 health care assistants. There were three ancillary staff, two activity coordinators sharing a shift from 10a.m. to 5p.m., two chefs; one for weekdays and one for the weekend, along with two assistants, a maintenance officer plus an administrator and a liaison officer. We formed the view that care staff were able to spend most of their time on providing care and support to people.

We looked at the staffing qualifications, which seemed appropriate to meet the needs of the people using services although there was evidence of a lack of applied knowledge in relation to pressure area care. From looking at the dependency levels of the people using services, we concluded that the staffing levels needed reviewing to ensure that peoples’ needs were appropriately met. A clearer system needed to be in place to determine the staffing levels required and this should be kept under review. In this respect consideration must be given to the fact that the home provides services such as nursing, dementia and end-of-life care to people. We looked at the quality of the end-of-life care that was provided to people which was basic and not in line with any particular model such as the Liverpool Care Pathway or the Gold Standards Framework. This was discussed with the manager during the course of our visits to the home.